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New Jersey rates for HCPCS 72158

Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$125.89 / $181.97 / $758.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $524.81 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.33 / $169.82 / $446.68
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.78 / $338.84 / $1,148.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $263.03 / $309.03
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.18 / $102.33 / $199.53
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $204.17 / $346.74
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $177.83 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$77.62 / $77.62 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $630.96 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.43 / $141.25 / $229.09
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.98 / $436.52 / $1,122.02
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $457.09 / $2,511.89
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.03 / $144.54 / $2,511.89
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$257.04 / $309.03 / $2,511.89
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $371.54 / $758.58
Horizon BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.33 / $109.65 / $186.21
Horizon BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$223.87 / $263.03 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $501.19 / $1,071.52
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $117.49 / $229.09
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $331.13 / $870.96